Kansas Voter Registration Form - Long Distance Voter
Kansas Voter Registration Form - Long Distance Voter
Kansas Voter Registration Form - Long Distance Voter
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<strong>Kansas</strong> <strong>Voter</strong> <strong>Registration</strong> Instructions<br />
For further information, contact the Office of the Secretary of State,<br />
1-800-262-VOTE (8683) V/TTY. This form is available at www.sos.ks.gov.<br />
You can use this application to:<br />
• register to vote in <strong>Kansas</strong><br />
• change your name, address, or affiliation with a political party<br />
To register to vote, you must:<br />
• be a U.S. citizen and a resident of the state of <strong>Kansas</strong>.<br />
• have reached the age of 18 years before the next election.<br />
• have received final discharge from imprisonment, parole, or conditional<br />
release if convicted of a felony.<br />
• have abandoned your former residence and/or name.<br />
How to register to vote:<br />
• Return your completed application to your county. Addresses are on<br />
the back of this application. Your county election officer will mail you a<br />
notice when your application has been processed.<br />
• Postmark this application by the 21st day before an election in order<br />
to be eligible to vote in that election.<br />
• If you decline to register to vote, that fact will remain confidential and<br />
will be used for voter registration purposes only. If you do register to<br />
vote, the office where you apply will be kept confidential and will be<br />
used for voter registration purposes only.<br />
• If this form is incomplete, it may be rejected.<br />
Identification number requirements<br />
Enter your current <strong>Kansas</strong> driver’s license number or nondriver’s identification<br />
card number. If you do not have either one, enter the last four digits<br />
of your Social Security number. If you do not have any of these numbers,<br />
write “none” in the box. The number will be used for administrative purposes<br />
only and will not be disclosed to the public. K.S.A. 25-2309<br />
Notice to voters<br />
You must provide a government-issued photo ID document at each<br />
election in order to obtain a ballot. Valid ID documents are: driver’s<br />
license or nondriver’s ID card issued by <strong>Kansas</strong> or another state, U.S.<br />
passport, concealed carry of handgun license issued by <strong>Kansas</strong> or<br />
another state, U.S. military ID, employee badge or ID document issued<br />
by a government office, student ID issued by an accredited <strong>Kansas</strong><br />
postsecondary educational institution, or public assistance ID card issued<br />
by a government office.<br />
Rev. 5/7/12 jdr<br />
Print in blue or black ink, fold on the center line, seal, and return.<br />
<strong>Kansas</strong> <strong>Voter</strong> <strong>Registration</strong> Application<br />
Warning: If you submit a false voter registration application,<br />
you may be convicted and sentenced to up to 17 months in prison.<br />
è<br />
Qualifications: If you mark “no” in response to either Question 1 or 2, do not complete this form.<br />
1. Are you a citizen of the United States of America? ○ Yes ○ No<br />
2. Will you be 18 years of age on or before Election Day? ○ Yes ○ No<br />
Last Name (please print) First Name Middle Jr. Sr. II III<br />
○ Male<br />
○ Female<br />
Residential Address (include apt. or space number) City County Zip<br />
Mailing Address (if different than residential address) City Zip Date Residence Established (MM/DD/YY)<br />
Birth Date (MM/DD/YY) Daytime Phone Number (if available) Naturalization Number (if applicable) Driver’s License Number or Last 4 Social Security (see instructions)<br />
Party Affiliation: Choose one of the following: ○ Democratic ○ Republican ○ Libertarian ○ Reform ○ Americans Elect ○ Not affiliated with a party<br />
Complete if previously<br />
registered (please print)<br />
Previous Name<br />
Previous Residential Address (Street, City, State, Zip, County)<br />
Signature: I swear or affirm that I am a citizen of the United States and a <strong>Kansas</strong> resident, that I will be 18 years old before the next election, that if convicted of a felony, I<br />
have had my civil rights restored, that I have abandoned my former residence and/or other name, and that I have told the truth on this application.<br />
Signature<br />
Date (MM/DD/YY)<br />
For office use only: Ward ______________________ Pct. ______________________ School Dist. ______________________ Member Dist. ______________________<br />
Sen. ________________ Rep. ________________ CoComm ________________ Section ________________ Township ________________ Range _________________
Kris W. Kobach, Secretary of State<br />
Memorial Hall, 1st Floor<br />
120 S.W. 10th Avenue<br />
Topeka, KS 66612-1594<br />
Post Office<br />
Will Not<br />
Deliver<br />
Without<br />
Postage<br />
County Election Officer<br />
_________________________________ County<br />
________________________________________<br />
__________________ KS __________________<br />
Allen County<br />
1 N. Washington<br />
Iola, KS 66749<br />
Anderson County<br />
100 E. 4th<br />
Garnett, KS 66032<br />
Atchison County<br />
423 N. 5th<br />
Atchison, KS 66002<br />
Barber County<br />
120 E. Washington<br />
Medicine Lodge, KS 67104<br />
Barton County<br />
1400 Main Rm 202<br />
Great Bend, KS 67530<br />
Bourbon County<br />
210 S. National<br />
Fort Scott, KS 66701<br />
Brown County<br />
601 Oregon St<br />
Hiawatha, KS 66434<br />
Butler County<br />
205 W. Central<br />
El Dorado, KS 67042<br />
Chase County<br />
Courthouse Sq / Box 529<br />
Cottonwood Falls, KS 66845<br />
Chautauqua County<br />
215 N. Chautauqua<br />
Sedan, KS 67361<br />
Cherokee County<br />
100 W. Maple / Box 14<br />
Columbus, KS 66725<br />
Cheyenne County<br />
212 E. Wash. / Box 985<br />
St Francis, KS 67756<br />
Clark County<br />
913 Highland St / Box 886<br />
Ashland, KS 67831-0886<br />
Clay County<br />
712 Fifth / Box 98<br />
Clay Center, KS 67432<br />
Cloud County<br />
811 Washington<br />
Concordia, KS 66901<br />
Coffey County<br />
110 S. 6th St Rm 202<br />
Burlington, KS 66839<br />
Comanche County<br />
201 S. New York / Box 776<br />
Coldwater, KS 67029<br />
Cowley County<br />
311 E. 9th<br />
Winfield, KS 67156<br />
Crawford County<br />
111 E. Forest / Box 249<br />
Girard, KS 66743-0249<br />
Decatur County<br />
P.O. Box 28<br />
Oberlin, KS 67749<br />
Dickinson County<br />
109 E. First / Box 248<br />
Abilene, KS 67410<br />
Doniphan County<br />
P.O. Box 278<br />
Troy, KS 66087<br />
Douglas County<br />
1100 Massachusetts St<br />
Lawrence, KS 66044<br />
Edwards County<br />
312 Massachusetts St<br />
Kinsley, KS 67547<br />
Elk County<br />
127 N. Pine / Box 606<br />
Howard, KS 67349<br />
Ellis County<br />
P.O. Box 720<br />
Hays, KS 67601<br />
Ellsworth County<br />
210 N. <strong>Kansas</strong><br />
Ellsworth, KS 67439<br />
Finney County<br />
311 N. 9th St., Box M<br />
Garden City, KS 67846<br />
Ford County<br />
100 Gunsmoke<br />
Dodge City, KS 67801<br />
Franklin County<br />
315 S. Main<br />
Ottawa, KS 66067<br />
Geary County<br />
200 E. 8th St<br />
Junction City, KS 66441<br />
Gove County<br />
P.O. Box 128<br />
Gove, KS 67736<br />
Graham County<br />
410 N. Pomeroy<br />
Hill City, KS 67642<br />
Grant County<br />
108 S. Glenn<br />
Ulysses, KS 67880<br />
Gray County<br />
P.O. Box 487<br />
Cimarron, KS 67835<br />
Greeley County<br />
P.O. Box 277<br />
Tribune, KS 67879<br />
Greenwood County<br />
311 N. Main<br />
Eureka, KS 67045<br />
Hamilton County<br />
219 N. Main / Box 1167<br />
Syracuse, KS 67878<br />
Harper County<br />
201 N. Jennings<br />
Anthony, KS 67003<br />
Harvey County<br />
8th & Main / Box 687<br />
Newton, KS 67114<br />
Haskell County<br />
300 Inman / Box 518<br />
Sublette, KS 67877<br />
Hodgeman County<br />
500 Main<br />
Jetmore, KS 67854<br />
Jackson County<br />
400 New York<br />
Holton, KS 66436<br />
Jefferson County<br />
P.O. Box 321<br />
Oskaloosa, KS 66066<br />
Jewell County<br />
307 N. Commercial<br />
Mankato, KS 66956<br />
Johnson County<br />
2101 E. <strong>Kansas</strong> City Rd<br />
Olathe, KS 66061<br />
Kearny County<br />
304 N. Main / Box 86<br />
Lakin, KS 67860<br />
Kingman County<br />
130 N. Spruce<br />
Kingman, KS 67068<br />
Kiowa County<br />
211 E. Florida<br />
Greensburg, KS 67054<br />
Labette County<br />
501 Merchant / Box 387<br />
Oswego, KS 67356<br />
Lane County<br />
144 S. Lane / Box 788<br />
Dighton, KS 67839<br />
Leavenworth County<br />
300 Walnut<br />
Leavenworth, KS 66048<br />
Lincoln County<br />
216 E. Lincoln Ave<br />
Lincoln, KS 67455<br />
Linn County<br />
P.O. Box 350<br />
Mound City, KS 66056<br />
Logan County<br />
710 W. 2nd<br />
Oakley, KS 67748<br />
Lyon County<br />
430 Commercial<br />
Emporia, KS 66801<br />
Marion County<br />
200 S. Third<br />
Marion, KS 66861<br />
Marshall County<br />
1201 Broadway<br />
Marysville, KS 66508<br />
McPherson County<br />
117 N. Maple<br />
McPherson, KS 67460<br />
Meade County<br />
P.O. Box 278<br />
Meade, KS 67864<br />
Miami County<br />
201 S. Pearl Ste 102<br />
Paola, KS 66071<br />
Mitchell County<br />
111 S. Hersey / Box 190<br />
Beloit, KS 67420<br />
Montgomery County<br />
217 E. Myrtle / Box 446<br />
Independence, KS 67301<br />
Morris County<br />
501 W. Main<br />
Council Grove, KS 66846<br />
Morton County<br />
1025 Morton / Box 1116<br />
Elkhart, KS 67950<br />
Nemaha County<br />
607 Nemaha / Box 186<br />
Seneca, KS 66538<br />
Neosho County<br />
100 S. Main / Box 138<br />
Erie, KS 66733<br />
Ness County<br />
202 W. Sycamore<br />
Ness City, KS 67560<br />
Norton County<br />
105 S. <strong>Kansas</strong> / Box 70<br />
Norton, KS 67654<br />
Osage County<br />
717 Topeka Ave / Box 226<br />
Lyndon, KS 66451-0226<br />
Osborne County<br />
423 W. Main / Box 160<br />
Osborne, KS 67473<br />
Ottawa County<br />
307 N. Concord Ste 130<br />
Minneapolis, KS 67467<br />
Pawnee County<br />
715 Broadway<br />
Larned, KS 67550<br />
Phillips County<br />
301 State St<br />
Phillipsburg, KS 67661<br />
Pottawatomie County<br />
207 N. 1st / Box 187<br />
Westmoreland, KS 66549<br />
Pratt County<br />
300 S. Ninnescah / Box 885<br />
Pratt, KS 67124<br />
Rawlins County<br />
607 Main<br />
Atwood, KS 67730<br />
Reno County<br />
206 W. First<br />
Hutchinson, KS 67501<br />
Republic County<br />
1815 M. Street<br />
Belleville, KS 66935<br />
Rice County<br />
101 W. Commercial<br />
Lyons, KS 67554<br />
Riley County<br />
110 Courthouse Plaza<br />
Manhattan, KS 66502<br />
Rooks County<br />
115 N. Walnut<br />
Stockton, KS 67669<br />
Rush County<br />
715 Elm / Box 220<br />
Lacrosse, KS 67548<br />
Russell County<br />
4th & Main / Box 113<br />
Russell, KS 67665<br />
Saline County<br />
300 W. Ash / Box 5040<br />
Salina, KS 67402<br />
Scott County<br />
303 Court St<br />
Scott City, KS 67871<br />
Sedgwick County<br />
510 N. Main<br />
Wichita, KS 67203-3798<br />
Seward County<br />
515 N. Washington Ste 100<br />
Liberal, KS 67901<br />
Shawnee County<br />
911 Sw 37th<br />
Topeka, KS 66611-2378<br />
Sheridan County<br />
925 9th St / Box 899<br />
Hoxie, KS 67740<br />
Sherman County<br />
813 Broadway Rm 102<br />
Goodland, KS 67735<br />
Smith County<br />
218 S. Grant<br />
Smith Center, KS 66967<br />
Stafford County<br />
209 N. Broadway<br />
St John, KS 67576<br />
Stanton County<br />
201 N. Main / Box 190<br />
Johnson, KS 67855<br />
Stevens County<br />
200 E. 6th<br />
Hugoton, KS 67951<br />
Sumner County<br />
501 N. Washington<br />
Wellington, KS 67152<br />
Thomas County<br />
300 N. Court Ave<br />
Colby, KS 67701<br />
Trego County<br />
216 Main<br />
WaKeeney, KS 67672<br />
Wabaunsee County<br />
215 <strong>Kansas</strong> / Box 278<br />
Alma, KS 66401<br />
Wallace County<br />
P.O. Box 70<br />
Sharon Springs, KS 67758<br />
Washington County<br />
214 C St<br />
Washington, KS 66968<br />
Wichita County<br />
206 S. 4th Drawer 968<br />
Leoti, KS 67861<br />
Wilson County<br />
615 Madison<br />
Fredonia, KS 66736<br />
Woodson County<br />
105 W. Rutledge Rm 103<br />
Yates Center, KS 66783<br />
Wyandotte County<br />
850 State Ave<br />
<strong>Kansas</strong> City, KS 66101
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